Medical
In accordance with Section 16-212 of Prince George’s County Code, Prince George’s County Government offers health plans for the exclusive benefit of its employees and retirees. These include two Health Maintenance Organization (HMO) plans and one Preferred Provider Organization (PPO) plan.
The Benefits and Pensions Division is responsible for three health plans serving approximately 9,400 active employees and retirees:
| 2022 Plan Documents | 2023 Plan Documents |
|---|---|
| 2022 Kaiser Permanente HMO (PDF) | 2023 Kaiser Permanente HMO (PDF) |
| 2022 Cigna Healthcare HMO (PDF) | 2023 Cigna Healthcare HMO (PDF) |
| 2022 Cigna Healthcare PPO (PDF) | 2023 Cigna Healthcare PPO (PDF) |
Please be advised that changes in benefit plans may be made only once a year during the open enrollment period unless there is a Qualifying Life Event.
2023 Active Employee Medical Plan Rates (Paid Biweekly)
| Kaiser Permanente | Cigna HMO | Cigna PPO | |
|---|---|---|---|
| Self Only | $64.31 | $69.10 | $108.27 |
| Self + 1 | $128.34 | $138.23 | $218.35 |
| Family | $185.98 | $193.28 | $306.65 |
2023 Crossing Guard Medical Plan Rates (Paid Biweekly)
| Kaiser Permanente | Cigna HMO | Cigna PPO | |
|---|---|---|---|
| Self Only | $83.60 | $89.83 | $140.75 |
| Self + 1 | $166.85 | $179.70 | $283.86 |
| Family | $241.78 | $251.27 | $398.64 |
2022 Active Employee Medical Plan Rates (Paid Biweekly)
| Kaiser Permanente | Cigna HMO | Cigna PPO | |
|---|---|---|---|
| Self Only | $63.17 | $69.10 | $108.27 |
| Self + 1 | $126.06 | $138.23 | $218.35 |
| Family | $182.66 | $193.28 | $306.65 |
2022 Crossing Guard Medical Plan Rates (Paid Biweekly)
| Kaiser Permanente | Cigna HMO | Cigna PPO | |
|---|---|---|---|
| Self Only | $82.12 | $89.83 | $140.75 |
| Self + 1 | $163.87 | $179.69 | $283.85 |
| Family | $237.46 | $251.27 | $398.64 |
The Kaiser Permanente HMO plan requires its members to see doctors who are located in the various Medical Centers throughout the Washington Metropolitan area. There are no deductibles and claim forms under the Kaiser Permanente HMO plan. The co-payments for office visits, laboratory services, and x-rays and other services range from $0 to $35 for Kaiser Permanente. Please see the Summary of Benefits to determine the applicable co-payments for services.
The Kaiser Permanente co-pay for emergency room services is $50 and $100 co-pay for each in-patient hospital admission. The Kaiser Permanente HMO plan does not include coverage for prescription, dental and vision benefits; it only covers medical health benefits.
Contact Kaiser Permanente
Customer Services and Claims: 1-888-225-7202
Member Services: 301-468-6000
Website: my.kp.org/princegeorgescountygovernment
2022 Plan Materials
2022 Kaiser Brochure (PDF)
Kaiser Permanente Medical Facilities Map (PDF)
2022 Specialty Care Flyer (PDF)
Manage Your Health Online (PDF)
Kaiser Care On-the-Go (PDF)
Video Visits (PDF)
KP Microsite for County Employees (PDF)
24/7 Virtual Care
Kaiser Permanente Members can now talk with a clinician 24/7 by video or phone. For details click here!
At-Home COVID-19 test kits:
According to the U.S. Department of Health and Human Services, insurance companies and health plans are required to cover eight (8) free over-the-counter at-home COVID-19 tests per covered individual per month. That means a family of four, all on the same health plan, would be able to get up to 32 at-home COVID-19 tests covered by their health plan per month. There is no limit on the number of tests, including at-home COVID-19 tests, that are covered if ordered or administered by a health care provider following and individualized clinical assessment, including those needed due to underlying medical conditions.
At-home tests can be paid for or reimbursed by health flexible spending arrangements (“Health FSAs”), health reimbursement arrangements (“HRAs”), or health savings accounts (“HSAs”). However, no double-dipping is allowed. In other words, at-home tests cannot be paid for or reimbursed by a Health FSA, HRA, or HSA, and also be paid for or reimbursed by a group health plan. You may not be reimbursed more than once for the same expense.
COVIDTests.gov - the federal government is now offering free rapid antigen tests by mail. Residential households in the U.S. can order one set of four (4) free at-home tests, without shipping fees, on covidetests.gov.
Kaiser Permanente (KP) Members - KP will reimburse members for FDA-approved rapid antigen home tests purchased on or after January 15, 2022. Visit the link to learn how to submit a reimbursement claim form.
Transparency in Coverage
Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, most group health plans, and issuers of group or individual health insurance will begin posting pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care. More requirements will go into effect starting on January 1, 2023, and January 1, 2024, which will provide additional access to pricing information and enhance consumers' ability to shop for the health care that best meet their needs.
More information on this rule can be found here: https://www.cms.gov/healthplan-price-transparency
Kaiser’s machine-readable files are located on kp.org
The Cigna HMO plan is an open-access network medical plan and there is no requirement to select a Primary Care Physician (PCP) or obtain a referral to a specialist. The co-payments for office visits, laboratory services, and x-rays and other services range from $0 to $35 for Cigna. Please see the Summary of Benefits to determine the applicable co-payments for services.
The Cigna plan co-pay for emergency room services is $150 and $50 for urgent care services. Additionally, the Cigna plan co-pay for out-patient hospital services is $100 and $250 for each in-patient hospital admission. Medical services are also available through the Convenience Care Clinics (Minute Clinics) under the Cigna plan for certain medical conditions.
Any non-emergency in-patient or out-patient procedure requires precertification that must be authorized by your health plan. The Cigna plan has a $50 individual annual deductible for certain in-network services that must be met each calendar year prior to any plan coverage. Please see the Summary of Benefits for the services that are subject to the annual deductible. The HMO plan does not include coverage for prescription, dental and vision benefits; it only covers medical health benefits.
Contact Cigna
Cigna Member Services - 1-800-244-6224
Website - myCigna.com
2022 Plan Materials
Cigna HMO Brochure (PDF)
Cigna Virtual Care (PDF)
Cigna One Guide - Health and Wellness Brochure (PDF)
Cigna's Vaccine Program
You may be able to get the seasonal flu shot – as well as other vaccines – at your local retail pharmacy. Depending on your plan, vaccines may be covered under your medical benefit at no cost-share ($0) to you. Plans vary so check your plan materials for details, including a current list of covered vaccinations and the pharmacies included in your specific plan’s network.
Cigna Vaccine Program (PDF)
At-Home COVID-19 test kits:
According to the U.S. Department of Health and Human Services, insurance companies and health plans are required to cover eight (8) free over-the-counter at-home COVID-19 tests per covered individual per month. That means a family of four, all on the same health plan, would be able to get up to 32 at-home COVID-19 tests covered by their health plan per month. There is no limit on the number of tests, including at-home COVID-19 tests, that are covered if ordered or administered by a health care provider following and individualized clinical assessment, including those needed due to underlying medical conditions.
At-home tests can be paid for or reimbursed by health flexible spending arrangements (“Health FSAs”), health reimbursement arrangements (“HRAs”), or health savings accounts (“HSAs”). However, no double-dipping is allowed. In other words, at-home tests cannot be paid for or reimbursed by a Health FSA, HRA, or HSA, and also be paid for or reimbursed by a group health plan. You may not be reimbursed more than once for the same expense.
COVIDTests.gov - the federal government is now offering free rapid antigen tests by mail. Residential households in the U.S. can order one set of four (4) free at-home tests, without shipping fees, on covidetests.gov.
Cigna Members - Cigna will reimburse members for FDA-approved rapid antigen home tests purchased on or after January 15, 2022. Visit the link to learn how to submit a reimbursement claim form.
Transparency in Coverage
Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, most group health plans, and issuers of group or individual health insurance will begin posting pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care. More requirements will go into effect starting on January 1, 2023, and January 1, 2024, which will provide additional access to pricing information and enhance consumers' ability to shop for the health care that best meet their needs.
More information on this rule can be found here: https://www.cms.gov/healthplan-price-transparency
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
https://www.cigna.com/legal/compliance/machine-readable-files
The Cigna PPO plan offers the convenience and cost savings of HMO-type (in-plan) benefits along with the freedom and flexibility of out-of-plan benefits. Please see the previous section on HMO plan features for information on the in-plan benefits.
The out-of-plan benefits enable you to access specialists or hospitals of your choice. This plan allows employees to use non-participating providers; however, a deductible, coinsurance, and any amounts over the usual and customary fee will apply. The out-of-plan benefit has a $300 deductible per individual/$550 per family that must be met each calendar year. Once the deductible has been met, the plan will pay 80% of the usual and customary fee. The employee is responsible for the remaining 20% copay, which is the coinsurance, and any amount charged over the usual and customary fee. The out-of-pocket maximums are $2,000 for Single and $4,000 for Family. The PPO plan does not include coverage for prescription, dental and vision benefits; it only covers medical health benefits.
Non-emergency in-patient and out-patient procedures require precertification. In-plan (HMO) providers are responsible for pre-certifying procedures. A procedure scheduled by out-of-plan providers requires the member and/or the doctor to obtain precertification.
Note: The member has the ultimate responsibility to obtain precertification for procedures performed by out-of-plan providers.
Contact Cigna
Cigna Member Services - 1-800-244-6224
Website - myCigna.com
2022 Plan Materials
Cigna PPO Brochure (PDF)
Cigna Virtual Care (PDF)
Cigna One Guide - Health and Wellness Brochure (PDF)
Cigna's Vaccine Program
You may be able to get the seasonal flu shot – as well as other vaccines – at your local retail pharmacy. Depending on your plan, vaccines may be covered under your medical benefit at no cost-share ($0) to you. Plans vary so check your plan materials for details, including a current list of covered vaccinations and the pharmacies included in your specific plan’s network.
Cigna Vaccine Program (PDF)
At-Home COVID-19 test kits:
According to the U.S. Department of Health and Human Services, insurance companies and health plans are required to cover eight (8) free over-the-counter at-home COVID-19 tests per covered individual per month. That means a family of four, all on the same health plan, would be able to get up to 32 at-home COVID-19 tests covered by their health plan per month. There is no limit on the number of tests, including at-home COVID-19 tests, that are covered if ordered or administered by a health care provider following and individualized clinical assessment, including those needed due to underlying medical conditions.
At-home tests can be paid for or reimbursed by health flexible spending arrangements (“Health FSAs”), health reimbursement arrangements (“HRAs”), or health savings accounts (“HSAs”). However, no double-dipping is allowed. In other words, at-home tests cannot be paid for or reimbursed by a Health FSA, HRA, or HSA, and also be paid for or reimbursed by a group health plan. You may not be reimbursed more than once for the same expense.
COVIDTests.gov - the federal government is now offering free rapid antigen tests by mail. Residential households in the U.S. can order one set of four (4) free at-home tests, without shipping fees, on covidetests.gov.
Cigna Members - Cigna will reimburse members for FDA-approved rapid antigen home tests purchased on or after January 15, 2022. Visit the link to learn how to submit a reimbursement claim form.
Transparency in Coverage
Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, most group health plans, and issuers of group or individual health insurance will begin posting pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care. More requirements will go into effect starting on January 1, 2023, and January 1, 2024, which will provide additional access to pricing information and enhance consumers' ability to shop for the health care that best meet their needs.
More information on this rule can be found here: https://www.cms.gov/healthplan-price-transparency
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
https://www.cigna.com/legal/compliance/machine-readable-files
The County offers employees who have medical insurance coverage through an external medical plan, or coverage under the County plans as a result of marriage to another County employee or retiree, to receive a stipend of up to $400 annually. The Opt-Out Credit is prorated and, if elected, is paid for months the employee is eligible for the employer contribution towards a health insurance premium. Employees will receive an equal portion of the payment in each payroll period.
Employees may choose to enroll in the Medical Opt-Out Credit each year by completing enrollment through Employee Self Service (ESS) Otherwise, the medical opt-out plan will terminate at the end of the current plan year.